P05 A targeted antimicrobial pharmacy technician ward service improves stewardship and patient-centred care and safety of commonly prescribed higher risk antimicrobials in the acute hospital setting

Abstract Background Evolving antimicrobial pharmacy technician (AMPT) roles provide opportunity to support antimicrobial stewardship (AS) and patient-centred care in hospital.1,2 Documenting antimicrobial stop dates on the electronic prescribing system (HEPMA) improves AS by ensuring patients receive the appropriate treatment duration.3 Keeping patients informed and involved4 when prescribing higher risk antimicrobials such as aminoglycosides,5 fluoroquinolones6 and other ‘4C’ agents (co-amoxiclav, clindamycin and cephalosporins) aids early detection and management of adverse effects and drug interactions, supporting treatment optimization and patient-centred care and safety. Objectives To develop a targeted AMPT ward service to improve AS and patient-centred care and safety of commonly prescribed higher risk antimicrobials in the acute setting. Methods A quality improvement (QI) approach was used to introduce an AMPT service to the Royal Alexandra Hospital inpatient wards. HEPMA reports were used to target AMPT review including: oral antimicrobial treatment courses without a stop date; IV gentamicin prescriptions; and ‘4C’, clarithromycin and fluconazole oral treatment courses. Electronic tools (Microsoft Forms®) were developed to support standardization of AMPT patient counselling, interaction management and data collection. ‘Antibiotics it’s OK to Ask’,7 fluoroquinolone6 and gentamicin5 patient information leaflets were provided, and referrals were made to the antimicrobial or ward pharmacist where appropriate. Wards achieving 75% documentation of oral antibiotic stop dates on HEPMA and AMPT interventions were collated as indicator measures of improvement. Results AMPT review identified the following. (i) Twenty-three percent (n=523) of oral antimicrobials without a stop date were ‘4C’ antibiotics and 9% fluoroquinolones. Thirty-five percent of patients were suitable for counselling; common barriers included cognitive impairment or poor clinical condition. Of those counselled, 18% were unsure antibiotics were prescribed, 64% knew the indication, 27% knew the antimicrobial agent and only 4% the planned duration. Twenty-three percent stated possible side effects, most commonly gastrointestinal upset. (ii) Sixty-nine percent (n=142) of fluoroquinolone, clarithromycin and fluconazole oral treatment courses were prescribed concomitantly with potentially serious interacting medications,8 42% (n=98) related to QTc prolongation and 15% were fluoroquinolone/multivalent cation interactions. (iii) Sixty percent (n=265) of patients prescribed IV gentamicin were suitable for counselling. Seventy-two percent knew gentamicin treated infection but only 12% knew about potential renal and ototoxicity prior to counselling. Twelve months after AMPT service introduction documentation of oral antimicrobial stop dates improved from baseline in 94% (n=18) (Table 1), and the 75% target was achieved in 22% of targeted wards, respectively (Figure 1).Table 1. Percentage of oral antimicrobials with a documented stop date on HEPMA Baseline, median, % (n) (April–December 2022) Post-change, median, % (n) (January 2023–January 2024) Target, % RAH medical wards  MW1 43 (358) 63 (289) 75  MW2 69 (143) 68 (277) 75  MW3 61 (207) 67 (241) 75  MW4 54 (216) 58 (362) 75  MW5 49 (270) 72 (406) 75  MW6 52 (244) 81 (460) 75  MW7 53 (171) 78 (323) 75  MW8 62 (156) 68 (278) 75  MW9 51 (199) 70 (322) 75 RAH surgical wards  SW1 31 (244) 53 (233) 75  SW2 49 (122) 71 (180) 75  SW3 53 (103) 93 (121) 75  SW4 60 (102) 69 (167) 75  SW5 43 (195) 57 (287) 75  SW6 27 (60) 60 (108) 75  SW7 48 (65) 70 (147) 75  SW8 48 (168) 59 (214) 75 RAH older people services/stroke wards 1,2,3,4,5 75 (408) 77 (894) 75Figure 1. Achievement of 75% target in targeted wards. Conclusions A targeted AMPT ward service resulted in improved AS and patient-centred care and safety of commonly prescribed higher risk antimicrobials in the acute hospital setting.

Background: Evolving antimicrobial pharmacy technician (AMPT) roles provide opportunity to support antimicrobial stewardship (AS) and patient-centred care in hospital. 1,2Documenting antimicrobial stop dates on the electronic prescribing system (HEPMA) improves AS by ensuring patients receive the appropriate treatment duration. 3Keeping patients informed and involved 4 when prescribing higher risk antimicrobials such as aminoglycosides, 5 fluoroquinolones 6 and other '4C' agents (co-amoxiclav, clindamycin and cephalosporins) aids early detection and management of adverse effects and drug interactions, supporting treatment optimization and patient-centred care and safety.
Objectives: To develop a targeted AMPT ward service to improve AS and patientcentred care and safety of commonly prescribed higher risk antimicrobials in the acute setting.
Methods: A quality improvement (QI) approach was used to introduce an AMPT service to the Royal Alexandra Hospital inpatient wards.HEPMA reports were used to target AMPT review including: oral antimicrobial treatment courses without a stop date; IV gentamicin prescriptions; and '4C', clarithromycin and fluconazole oral treatment courses.Electronic tools (Microsoft Forms ® ) were developed to support standardization of AMPT patient counselling, interaction management and data collection.'Antibiotics it's OK to Ask', 7 fluoroquinolone 6 and gentamicin 5 patient information leaflets were provided, and referrals were made to the antimicrobial or ward pharmacist where appropriate.Wards achieving 75% documentation of oral antibiotic stop dates on HEPMA and AMPT interventions were collated as indicator measures of improvement.
Results: AMPT review identified the following.(i) Twenty-three percent (n=523) of oral antimicrobials without a stop date were '4C' antibiotics and 9% fluoroquinolones.Thirty-five percent of patients were suitable for counselling; common barriers included cognitive impairment or poor clinical condition.Of those counselled, 18% were unsure antibiotics were prescribed, 64% knew the indication, 27% knew the antimicrobial agent and only 4% the planned duration.Twenty-three percent stated possible side effects, most commonly gastrointestinal upset.(ii) Sixty-nine percent (n=142) of fluoroquinolone, clarithromycin and fluconazole oral treatment courses were prescribed concomitantly with potentially serious interacting medications, 8 42% (n=98) related to QTc prolongation and 15% were fluoroquinolone/multivalent cation interactions.(iii) Sixty percent (n=265) of patients prescribed IV gentamicin were suitable for counselling.Seventy-two percent knew gentamicin treated infection but only 12% knew about potential renal and ototoxicity prior to counselling.Twelve months after AMPT service introduction documentation of oral antimicrobial stop dates improved from baseline in 94% (n=18) (Table 1), and the 75% target was achieved in 22% of targeted wards, respectively (Figure 1).
Conclusions: A targeted AMPT ward service resulted in improved AS and patientcentred care and safety of commonly prescribed higher risk antimicrobials in the acute hospital setting.Public Health Wales, UK 1 This risk is compounded by the increasing prevalence of antimicrobial resistance limiting treatment options. 2 This insertion was complicated by vancomycin-susceptible Enterococcus faecium bacteraemia with PET scan demonstrating abnormal update within the LVAD system.He was treated with 6 weeks of IV vancomycin and was discharged to the outpatient setting to continue 6 weekly dalbavancin for the next 12 months.Nine months into treatment, bacteraemia recurred and susceptibilities demonstrated the organism had become resistant to vancomycin.Long-term, non-toxic treatment options were needed as, due to the complex nature of the LVAD device, removal was not viable.Treatment choices were limited, and because of the toxic effects associated with long-term linezolid use, daptomycin was chosen as a daily OPAT option.Subsequent daptomycin MIC testing suggested this would be ineffective (MIC=12) and his treatment was switched to minocycline plus rifampicin.Further testing demonstrated rifampicin resistance (MIC=32) and minocycline partial resistance (MIC=4).The patient remains stable and asymptomatic in the community on minocycline whilst further long-term therapeutic options are considered to suppress infection in this challenging case.

Table 1 .
Percentage of oral antimicrobials with a documented stop date on HEPMA Figure 1.Achievement of 75% target in targeted wards.1 1 1